Hematuria Flashcards
What is GROSS hematuria?
- VISIBLE blood in the urine
- urological cancer is found 23% of the time.
- no etiology is found only 8% of the time.
** What is MICROSCOPIC hematuria? (TEST QUESTION)
- greater than 3 RBC/hpf in a single specimen.
* 43% of the time there is no evident cause.
** How the body help to treat a large bladder clot? (TEST QUESTION)
- urokinase= converts plasminogen to plasmin, leading to clot lysis.
What are some drugs that can cause red urine?
- RIFAMPIN
- phenazopyridine
- sulfamethoxazole (Bactrim)
- Nitrofurantoin
- Ibuprofen
- Phenytoin
- Methyldopa
- Chloroquine
- Phenacetin
- Levodopa
- Quinine
How sensitive and specific is a urine dip stick?
- 95% sensitive
- 75% specific
- MUST GET MICROSCOPIC URINALYSIS if you get a positive result on dip stick screening test.
What is a microscopic urinalysis?
- clean catch or catheterized urine is centrifuged and then examined under hpf.
What microscopic urinalysis results would point you toward a nephrologic cause?
- 2+ protein (proteinuria), dysmorphic RBCs, or RBC casts
What are the 3 general causes of hematuria?
- glomerular (nephrology)
- nonglomerular (upper or lower tract)
- pseudohematuria
What is your DDx for hematuria?
- period (pseudohematuria)
- prostatitis, prostate cancer, BPH
- obstructive uropathy (nephrolithiasis or ureteral tumors).
- nephritis (glomerulonephritis, interstitial nephritis…)
- trauma of GU system
- tumors of the GU system (bladder, renal, ureteral, prostatic).
- hematologic (anticoagulation, bleeding disorders, sickle cell)
- infection/inflammation (cystitis, pyelonephritis, chronic foley, TB)
- stones
- previous irradiation or chemo
- arteriovenous fistula
- beet consumption
- occupational exposure
How do you evaluate hematuria?
- thorough H&P
How should you carry out a diagnostic eval of hematuria?
- microscopic urinalysis
- urine culture
- urine cytology
- cystoscopy
- imaging
What is urine cytology?
- microscopic examination of exfoliated urothelial cells obtained by voided urine or bladder washings.
- cells are less cohesive in poorly differentiated tumors, therefore, cytology will be more likely to detect the tumor.
Should you always do urine cytology?
- ALWAYS for GROSS hematuria, but optional for microscopic hematuria.
Should you always do cystoscopy?
- ALWAYS for GROSS hematuria, but optional in patients less than 35 y/o with microscopic hematuria.
What is the gold standard imaging eval?
- CT urogram= CT of the abdomen and pelvis with 3 phases (noncontrast, nephrogenic, and excretory).
What are some additional tests to consider?
- CBC
- BMP (check creatinine)
- PSA
- coagulation parameters
When should you send a patient to the ER?
- If the patients are passing clots.
- Do NOT feel like they are emptying their bladder.
- associated with dizziness or hypotension
How do you treat gross hematuria?
- resuscitate with transfusion if necessary.
- consider holding anticoagulation
- place a LARGE foley to HAND irrigate the bladder.
- if severe, may need to start continuous bladder irrigation (3 way foley catheter)
What should you do if gross hematuria persists for days?
- OR for cystoscopy and endoscopic intervention
What can cause hematuria in pregnancy?
- spontaneous renal rupture
- placenta percreta
What are some predisposing risk factors for bladder cancer?
- recurrent UTIs
- chronic indwelling foley catheters
What are most bladder cancers?
- urothelial (transitional cell) carcinoma
